Normal body temperature typically hovers around 37°C (98.6°F), with a variation of about 0.6° either way. When the body encounters an infection or inflammation, the brain reacts by increasing the body temperature as part of its defence strategy. Fever serves as a protective mechanism, aiding the body in fighting off illness. A rectal temperature above 38°C (100.4°F) is classified as a fever. Elevated body temperature plays two significant roles: it helps control the disease process and acts as a critical signal indicating that the body is under stress, prompting a search for the underlying issue. Although fever can cause discomfort in children and increase the body’s metabolic demands, it is neither inherently good nor bad. Instead, it functions as a messenger, signalling that the body is actively responding to a problem.
Relying on touch to assess body temperature is imprecise and unreliable. Using a digital thermometer is the recommended method for measuring temperature. Avoid using mercury thermometers, as they pose a risk of breakage and are toxic. While taking a temperature rectally provides the most accurate reading, this method requires skill and may be uncomfortable for the child. The axillary (armpit) method is widely used for children and offers reasonably accurate results. It’s essential to note that axillary temperatures are typically 0.5–1.0°F lower than oral temperatures, whereas rectal temperatures are 0.5–1.0°F higher than oral readings.
Instructional video to check infant axillary temperature by digital thermometer https://www.youtube.com/watch?v=IdjwN2vSL5M
Instructional video to check rectal and oral temperature https://www.youtube.com/watch?v=cNKUWOS3o4g
Digital thermometers have improved sensor accuracy and now include features like memory storage, flexible tips, and rapid-read technology.
Infrared detection technology ensures more precise readings, even compensating for ear canal size and conditions. Crying, otitis media, and earwax have not been shown to change tympanic readings significantly.
Refined infrared scanning allows real-time temperature tracking across the forehead, providing more consistent results. It can be used in infants 3 months or older. It is a promising tool for screening children at low risk in hospitals but cannot be recommended for home or hospital use when definitive measurements are required.
New models include AI-driven calibration to adjust for ambient temperature and skin emissivity, enhancing accuracy for contactless measurement. Their use is currently not recommended either at home or in a hospital setting. The prime utility of such devices is in mass screening of large populations.
While largely replaced by digital alternatives, mercury thermometers remain a benchmark for comparison in research due to their precision.
Fever acts as the body’s natural defence mechanism and can arise due to several reasons, including:
In children, most fevers are harmless and resolve on their own. Viral infections are the leading cause and often do not require extensive treatment. However, your paediatrician may recommend tests to identify the underlying reason for prolonged or unexplained fever.
Fever can sometimes follow vaccinations, which are designed to protect the body from infectious diseases. Vaccines contain weakened or inactivated forms of disease-causing organisms to stimulate the immune system. When introduced into the body, the vaccine activates immune cells, which release inflammatory markers. This immune response may result in fever, swelling, and pain at the injection site. Post-vaccination fever is usually mild and self-limiting. In some cases, your paediatrician may suggest medication to ease discomfort and help your child feel better.
How should I manage my child’s fever at home?
When a child develops a fever, the primary focus should be identifying its underlying cause. Fever is a symptom, not a condition, so determining its root cause is essential. The primary goal of managing fever is to alleviate the child’s discomfort rather than merely lowering the temperature.
To help your child feel more comfortable during a fever, consider the following steps:
Tepid sponging is a technique used to reduce fever and make a child more comfortable. Here’s a step-by-step guide:
Fever in children is most often triggered by viral infections. Antibiotics, which are designed to treat bacterial infections, do not work against viruses. Therefore, using antibiotics for every case of fever is unnecessary and should be avoided. When your child has a fever, the decision to prescribe antibiotics will depend on your doctor’s assessment of whether a bacterial infection is suspected.
Fever can cause discomfort and muscle aches, making children irritable and low in energy. Keeping the child hydrated is crucial during a fever. Encourage them to take small sips of water and consume light meals. If the child is unable to take in anything, including fluids or breast milk, it is important to consult a doctor promptly.
While most fevers in children are not cause for alarm, it’s important to consult a paediatrician promptly if your child is under 3 months old or shows any of the following signs:
Conversely, certain signs can be reassuring when your child has a fever:
These positive indicators suggest that the fever may be mild and the child is coping well. However, always trust your instincts as a parent and seek medical advice if you’re concerned.
Febrile seizures are convulsions that can happen in children during a fever, typically between the ages of 6 months and 5 years. A child is more likely to experience febrile seizures if there is a family history of them or if they have had one previously. Most children outgrow febrile seizures by the age of 5. There is no evidence to suggest that the severity of a fever increases the likelihood of febrile seizures or causes brain damage. Additionally, these seizures do not raise the risk of developing epilepsy later in life.
Medications for children are given based on their body weight, as incorrect dosages can result in toxicity or unwanted side effects. It is essential to consult a paediatrician before giving any medication to your child. Additionally, different brands may have varying formulations and strengths, so it’s important to double-check with the pharmacist to ensure you’re purchasing the correct medicine.
Paracetamol (acetaminophen) is considered the safest medication for reducing fever in children when given at the appropriate dose of 15 mg/kg of body weight. It provides relief by reducing discomfort and pain rather than aiming to normalise the body temperature. For instance, if a child’s fever is 104°F, paracetamol may lower it to around 101°F but may not eliminate the fever completely.
For children who cannot take medicine orally, a paediatrician might recommend a paracetamol suppository administered rectally. It is crucial to avoid overdosing, even if the fever doesn’t fully subside. The next dose can be given after 4–6 hours if necessary.
Other options, like ibuprofen, may also be used under medical guidance. At a dose of 10 mg/kg, ibuprofen is as effective as paracetamol in reducing fever but is associated with a higher risk of side effects. In some cases, a combination of paracetamol and ibuprofen may be prescribed for quicker relief, though studies suggest it doesn’t significantly improve overall outcomes and may increase the risk of side effects.
Mefenamic acid is a good drug to reduce the temperature but not as safe as Paracetamol is. Medications like aspirin and nimesulide should also be avoided for managing fever in children, as they can cause harmful side effects. Always consult a paediatrician before administering any medication to your child.
Dr. Debarati Das is renowned for her holistic approach to child healthcare. With an illustrious career dedicated to pediatric wellness, she specialises in preventive care, chronic disease management, and the emotional well-being of children. Her expertise and empathy make her a beacon of hope for every family at Stepcare.
